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My surgery application was denied by Fed BCBS.

cyndi990

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AnnieM22    13

AnnieM22
Posted

I also have FEP BCBS. I was sleeved on December 14 2016. I, too had to have all of the requirements you mentioned. I also know someone else who was sleeved earlier in the year with the same insurance, and he also had those requirements. I really hope the peer to peer helps you out! Good luck!

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elisa5150    212

elisa5150
Posted

If you were seen even for an annual physical and were weighed then you can use that info to appeal.

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clc9    644

clc9
Posted

You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

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ready_to_be_thin    179

ready_to_be_thin
Posted (edited)

You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

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I don't think that every obese person would opt to have surgery, but I do still think they should pay for weight related issues. My surgery didn't cost $20k, closer to $8k. Weight related issues cause insurance companies to spend a ton of money, so I do still think they should pay for weight loss help. I believe it would save money in the long run due to the amount of money that is spent on weight related issues such as sleep apnea, diabetes, etc, etc. I certainly agree with them having an approval process, but there are some that just downright refuse to pay for anything weight related at all, like my insurance company. Mine does not pay for it at all, appeal or not. It is outlined in our insurance so it doesn't matter what problems you may have. So I didn't have a chance unfortunately. I am not trying to start an argument, its just my opinion. Thanks!

Edited by ready_to_be_thin

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sonkat5355    70

sonkat5355
Posted

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it ????.

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

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Paying out of pocket....Cigna Insurance does not pay.

????sonkat5355????

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cyndi990    31

cyndi990
Posted

It's 11200$ for the sleeve package you stay one night in the hospital too not just an outpatient procedure ! Still nervous though

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Wow that's awesome.

Dr Umbach charges 10,400 cash for outpatient clinic.

Don't worry you Will be fine. I'm sending prayers your way and good vibes . ???? also I don't if you've heard. There's a wonderful support group on Facebook called . Gastric sleeve support group. Gastric sleeve worrier.

They both are closed groups Check them out there is 62k members a lot of veterans and newbies . Best of luck with your sergury.

Keep me posted.

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